Provider Demographics
NPI:1437285269
Name:STEFAN UNTERHALTER MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEFAN UNTERHALTER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:UNTERHALTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-274-2722
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-274-2722
Mailing Address - Fax:310-275-1082
Practice Address - Street 1:9001 WILSHIRE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1838
Practice Address - Country:US
Practice Address - Phone:310-274-2722
Practice Address - Fax:310-275-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33152207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
110011556OtherMEDICARE RAILROAD
CA00A331520Medicaid
A33152Medicare ID - Type Unspecified